Hypo thyroidism

Question 1

Epidemiology - myxodema

Answer 1

10% of women and 6% of men. Any age but more common @ 65+ but harder to diagnose

Hypothyroidism is most prevalent in elderly populations, with 2-20% of older age groups having some form of hypothyroidism

Risk factors include
age (older than age 50),
female
obesity
thyroid surgery

Question 2

Atiology

Answer 2

Primary (Autoimmune - Hashimoto’s thyroiditis and goiter OR post cancer therapy)

Secondary (Hypothalamus reduces production of thyrotropin stimulating hormone OR pituitary reduces production of thyroid stimulating hormone) - uncommon

iodine deficiency or lithium use

Question 3

Pathophysiology

Answer 3

Although hypothalamic or pituitary disorders can affect thyroid function,
localized disease of the thyroid gland that results in decreased thyroid hormone production is the most common cause of hypothyroidism.

Hashimoto’s disease (example of Type 4 hypersensitivity) (auto immune thyroiditis + goitre, women over 60) where immune system attacks thyroid tissue

Question 4

Natural History

Answer 4

insidious, progressive, fatal

Question 5

Clinical Manefestations

Answer 5

dull facial expression, slow and hoarse voice, dry skin and brittle hair, weight gain due to water retention, puffy face and eyes,

less obvious in elderly, with arthralgia

Question 6

Symptoms

Answer 6

fatigue, cold intolerance, forgetfulness, constipation, dementia or psychosis, depression, menstrual disturbances, decreased perspiration, blurred vision, reduced hearing, anorexia

Question 7

Signs

Answer 7

bradycardia, effusions,

initially hard firm goitre -> advanced disease thyroid atrophy,

Question 8

Complications

Answer 8

myxedema coma (with hypothermia, seizures, respiratory depression, areflexia , myxedema madness,

Question 9

Prognosis

Answer 9

reversal of symptoms with treatment